Abstract
ObjectiveThe experiences of frontline healthcare professionals are essential in identifying strategies to mitigate the disruption to healthcare services caused by the COVID-19 pandemic.MethodsWe conducted a cross-sectional study of TB and HIV professionals in low and middle-income countries (LMIC). Between May 12 and August 6, 2020, we collected qualitative and quantitative data using an online survey in 11 languages. We used descriptive statistics and thematic analysis to analyse responses.Findings669 respondents from 64 countries completed the survey. Over 40% stated that it was either impossible or much harder for TB and HIV patients to reach healthcare facilities since COVID-19. The most common barriers reported to affect patients were: fear of getting infected with SARS-CoV-2, transport disruptions and movement restrictions. 37% and 28% of responses about TB and HIV stated that healthcare provider access to facilities was also severely impacted. Strategies to address reduced transport needs and costs–including proactive coordination between the health and transport sector and cards that facilitate lower cost or easier travel—were presented in qualitative responses. Access to non-medical support for patients, such as food supplementation or counselling, was severely disrupted according to 36% and 31% of HIV and TB respondents respectively; qualitative data suggested that the need for such services was exacerbated.ConclusionPatients and healthcare providers across numerous LMIC faced substantial challenges in accessing healthcare facilities, and non-medical support for patients was particularly impacted. Synthesising recommendations of frontline professionals should be prioritised for informing policymakers and healthcare service delivery organisations.
Highlights
The direct health effects of the COVID-19 pandemic are colossal, and are continuing to grow, with approximately one million deaths directly attributed to COVID-19 [1]
Over 40% of respondents stated that it was impossible or much harder for TB and HIV patients to reach healthcare facilities since COVID-19. It was much harder or impossible for TB healthcare providers to reach their place of work since COVID-19 began, according to 37% of respondents
We received more responses about TB than HIV. Data from this first multi-country survey focusing on experiences of frontline professionals showed that challenges to accessing healthcare facilities and maintaining routine service delivery– in relation to diagnostics and non-medical support—were substantial across low and middleincome countries (LMIC) following COVID-19
Summary
The direct health effects of the COVID-19 pandemic are colossal, and are continuing to grow, with approximately one million deaths directly attributed to COVID-19 [1]. Researchers and practitioners have already highlighted that the indirect effects of COVID-19 on global health—through the disruption of essential healthcare services—may be even larger and longer lasting [2, 3]. TB and HIV are the two infectious diseases that cause the highest number of deaths globally; in 2018, 1.5 and 1.1 million people died from TB and from HIV-related illnesses respectively [4, 5]. A modelling study estimating the impact of severe disruptions to service delivery predicted that HIV and TB deaths could increase by up to 10% and 20% over five years respectively in high-burden settings, reverting to levels seen a decade ago [9]
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